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Flashcards in Vessels UWorld 2 Deck (52)
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Defect in ApoE3 and ApoE4

Familial dysbetalipoproteinemia. Liver cannot remove chylomicrons and VLDL remnants from cirulation --> serum cholesterol and triglyceride elevation. Xanthomas and premature heart and vessel disease

1

ApoA-1

LCAT acivation, cholesterol esterification

Chylomicrons and HDL

2

ApoB-48

Chylomicron assembly and secretion by intestine

Chylomicron and remnants

3

ApoB-100

Binds LDL receptor, LDL uptake by extrahepatic cells

VLDL, IDL, LDL

4

ApoC-II

Lipoprotein lipase activation

Chylomicron, HDL

5

ApoE

VLDL, chylomicron uptake by liver

Chylomicron, remnant, VLDL, IDL, HDL

6

Dilated tortuous veins: risk factors, complications

Varicose veins. Long periods of standing, age, obesity, multiple pregnancies, genetic defects.

Complications include painful thromboses, skin ulcerations, dermatitis, infection, poor wound healing

7

Embryonic vein derivatives: vitelline, umbilical, cardinal

Vitelline --> portal
Umbilical degenerate
Cardial --> systemic

8

Atherosclerosis begins with injury to which cell type?

Repetitive endothelial injury, leads to chronic inflammatory state in the intima

9

What meds cause hyperkalemia

Things that interfere with aldosterone (ACE-I, ARBs, K-sparing diuretics, NSAIDs)

Cardiac glycosides

Non-selective beta blockers

10

After endothelial injury, what causes intimal thickening?

Smooth muscle cells, collagen deposition. Intimal hyperplasia and fibrosis results.

11

Earliest lesion of atherosclerosis

Intimal fatty streaks of intimal lipid-filled foam cells

12

What makes up foam cells?

Macrophages and smooth muscle cells that have engulfed LDL

13

Equation for net filtration pressure

Hydrostatic pressure gradient - oncotic pressure gradient

14

Side effects of niacin (B3)

Exacerbates gout, acanthosis nigricans (hyperglycemia), red flushed face/vasodilation, hepatitis

15

What meds increase serum uric acid levels?

Niacin, hctz, cyclosporine, pyrazinamide

16

Most important risk factor for aortic dissection

hypertension

17

Why do ACE inhibitors increase serum creatinine? What affect does this have in pts with renal artery stenosis?

Reduce ATII, causing decreased efferent arterial tone --> efferent dilation. Decreases glomerular pressure and renal perfusion. Pts with renal artery stenosis are dependent on efferent constriction to keep perfusion high, so this can cause renal failure

18

Statins decrease cholesterol synthesis. What is the LDL receptor response?

Increased receptor density

19

What is abnormal in varicose veins?

Incompetent venous valves --> venous hypertension, retrograde flow from deep to superficial veins in extremities

20

What tissue extracts the most oxygen from blood?

Heart. 75-80% at rest, up to 90% with exercise

21

What 2 lipid lowering agents can cause gallstones?

Fibrates and bile acid resins

22

Genomic imprinting

An offspring's genes are expressed in a parent specific manner. Produced by methylation (epigenetics)

23

Alpha 1 agonist: effects on heart

Directly increases contractility, but that is usually overridden by reflex decreases in rate, conduction, and contractility due to contraction of vascular smooth muscle

24

Cystic medial degeneration

Myxomatous changes in large arteries. Fragmentation of elastic tissue, separation of elastic and fibromuscular components of media by small spaces filled with extracellular matrix.

Seen in Marfan syndrome

25

Hyaline arteriolosclerosis: describe it, and who does it happen to

Homogenous deposition of eosinophilic hyaline material in intima and media of small arteries/arterioles. Lumen is narrowed.

Seen in non-malignant hypertension and diabetes

26

Compare and contrast giant cell arteritis and Takayasu arteritis

Both have granulomatous inflammation of media

GC affects branches of carotid artery, older patients.
T affects arch of aorta and proximal great vessels

27

What vessels are spared in polyarteritis nodosa?

Pulmonary

28

Norepinephrine extravasation

NE leak causes a1 vasoconstriction which can lead to local necrosis. Presents as cold, hard, pale local tissue. Can be prevented with an alpha blocker, such as phentolamine (must be done within 12 hr)

29

Alpha blockers (2 non selective, 2 a1, 1 a2)

Nonselective: Phenoxyenzamine (irreversible), phentolamine (reversible)

a1: Prazosin (other -zosins), tamsulosin
a2: Mirtazapine